December 18, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 18, 2015
Volume 15, Number 47

Dear Colleagues:

If you have claims outstanding with Health Republic, please take a moment to click on this link which will bring you to MSSNY’s grassroots action center and a letter which you can send to your elected State Senator and Assemblyman to call for action to assure that physicians and other healthcare stakeholders are paid for services rendered to patients of the now defunct Health Republic.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  MSSNY also continues to share with key legislators and the media our collective concerns regarding the severe consequences to physicians’ practices as a result of the collapse of Health Republic, and advocating for a special fund to assure physician claims for care provided to HR-insured patients are fully paid.

This includes sharing the results of our survey of nearly 1,000 respondents, which has generated extensive media coverage from across New York State, including the Wall Street Journal and New York Times.  Please add your voice to these efforts to better assure that physicians are not left holding the proverbial bag!

Submit All Your Claims Now!

In the meantime, you must submit all HR claims for services rendered up to and including November 30, 2015. Although we cannot project the outcome of this debacle, it is safe to report that if your claims are not filed, they will never be considered.

Send Us Your Bounced Checks!

MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds. If you have received notice from your bank that an HR check bounced, send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction.

On a related matter, if you are holding reimbursement checks from HR, they will bounce if you try to deposit it.  We urge you to send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor. Again, please email rmcnally@mssny.org.

Thank you for your patience while we continue to assist you in the process.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance



Alert from MSSNY General Counsel Don Moy:  NYS Court of Appeals Decision Exposes Physicians and Other Health Care Professionals to Liability to Non-Patient Members of the General Community
The majority’s decision in Davis v. South Nassau Communities Hospital must be viewed as alarming to physicians and other health care professionals.  Physicians who administer or prescribe medication to patients must be prepared to document that they advised the patient of the foreseeable side effects of the medication, and, in particular, if the medication could foreseeably impair the patient’s ability to safely operate an automobile. Physicians must be prepared to document that they advised the patient not to drive while taking the medication.

These are the facts in Davis v. South Nassau Communities Hospital (issued on December16, 2015): Patient W was treated by Dr. H at the ER of a hospital. As part of the treatment, the doctor intravenously administered to W an opioid narcotic painkiller and a benzodiazepine drug, and, allegedly, failed to warn W that such medication could impair her ability to safely operate an automobile. Shortly thereafter, W drove herself from the hospital and, while allegedly impaired by the medication administered to her, she crossed a double yellow line and struck a bus driven by plaintiff Davis.

The NYS Court of Appeals reversed an appellate court and held that under these facts, the doctor had a duty to warn the patient about the patient’s ability to drive safely, and the failure of the doctor to fulfill this duty to the patient could subject the doctor to liability to any member of the general community who is harmed as a result of the patient’s driving. The Court of Appeals opined that the “cost” of the duty  imposed upon physicians and hospitals is a “small one” because the “duty” requires the doctor to do no more than simply warn the patient of the dangers of driving. The Court emphasized that the doctor had no obligation to prevent the patient from driving.

The Court further held that its ruling does not create a new obligation on doctors because a doctor who administers prescribed medication already has a duty to advise the patient of the foreseeable side effects of the medication.  Rather, stated the Court, the ruling “merely extends” the scope of persons who may sue the doctor for failing to fulfill that responsibility to the patient.

The Court sought to limit the reach of its decision by stating that this decision should not be construed as an erosion of judicial precedent that courts need to proceed cautiously and carefully in recognizing a new “duty of care”.  Judge Leslie Stein issued a scathing dissenting opinion  and rebuked the majority decision  as  “precipitous” and contrary to the firmly established judicial precedent of the state that, in general, a physician’s duty is to the patient, and the corresponding liability may be extended to a non-patient only in rare and narrow circumstances, such as to an immediate family  member  where the physician knew or should have known  that treatment provided to the patient  could create risk of harm to immediate family members. To her knowledge, stated Judge Stein, there has been no precedent in the state that has held that a physician’s medical treatment of a patient could expose the physician to liability to an unidentified class of members of the general community.

Judge Stein stated that despite the majority’s attempt to limit the reach of its decision, she feared a “slippery slope” and that the decision could be precedent to expand liability to doctors in other areas of treatment. 


Congress Passes Year End Spending, Tax Relief Bills that Includes “Cadillac Tax” Delay, Extension of 9/11 Responder Health Coverage, and MU Hardship Provisions
The US House and Senate passed two massive legislative packages, an omnibus appropriations bill and tax revision bill, before Congress adjourned for the holidays.  Importantly, among the provisions is a 2-year delay of the so-called “Cadillac Tax” on benefit-rich health insurance plans enacted as part of the ACA that was to become effective in 2018.  Since this tax would strongly discourage employers from offering comprehensive health insurance coverage to their employees, the MSSNY House of Delegates adopted policy calling for this tax to be repealed.

The $1.1 trillion FY2016 omnibus appropriations package will fund federal agencies and programs through September 30, 2016. Many of the earlier debated policy riders, such as the proposal to “defund” Planned Parenthood, were omitted from the bill. In addition to the delay of the “Cadillac tax”, some of the other health-related provisions include the following:

  • Funds for the 9/11 emergency responder health care benefits were reauthorized and expanded;
  • A one-year delay of the health insurance tax (for 2017)
  • IPAB operational funding was cut by $15B (although the panel has never actually been established)
  • Requiring the HHS Secretary to implement an education campaign to inform breast cancer patients about the availability and coverage of breast reconstruction and other available alternatives post-mastectomy.
  • Breast cancer screening recommendations issued by the USPTF were blocked for 2 years
  • AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding)
  • Funding for NIH was increased by $2B
  • Additional funds were provided for opioid prescription drug overdose prevention
  • $20M was provided for the National Diabetes Prevention Program
  • The annual ban on using CDC funding for gun violence epidemiological research was extended

A second $650B package extends a broad range of tax-related polices, including a two-year moratorium on the Medical Device Tax, also enacted as part of the ACA.

Moreover, there was a “last second” bill passed by Congress that grants CMS the authority to expedite applications for exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year through a more streamlined process, alleviating burdensome administrative issues for both providers and the agency.  In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015.  However, CMS did not publish the Modifications Rule for Stage 2 of meaningful use until Oct. 16. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.  The legislation is designed to address this flaw.

Click here for a more detailed summary from the AMA on Congress’ action.


State Supreme Court Justice Ruled Child Flu Vaccination Not Mandatory in NYC
State Supreme Court Justice Manuel Mendez ruled Thursday that the New York City Department of Health and Mental Hygiene (DOHMH) may not require that children receive a flu vaccination to attend “city-licensed preschools and day care centers, striking down one of the more ambitious public health initiatives of the Bloomberg administration.” Justice Mendez ruled that “the city had exceeded its authority” and if the city wants to require flu vaccines, the Legislature would have to vote to add it to the list. 

Physicians Dropped from Emblem Should Contact Their State and Federal Legislators To Supplement MSSNY’s Advocacy


Physicians who have been unfairly dropped from Emblem’s participating physician network are urged to contact their state and federal legislators from MSSNY’s Grassroots Action Site here and ask for them to take action to push Emblem to reverse its decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services, as well as the NYS Department of Health and Attorney General’s office.

Moreover, MSSNY has written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.   MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Importantly, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani last week to ask for “further clarity on this issue.”   Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.     


MSSNY and OASAS To Conduct CME Webinars On Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free, four part webinar series on opioid prescribing.  Entitled,Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open at here.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Tuesday January 26, 2016, 12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Seltzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.


MSSNY Is Member of AMA’s Task Force On Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do.“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.


NYS Connects with Other Prescription Monitoring Programs; Allows Prescribers to Assist In Reducing Doctor Shopping Across State Lines
New York State has announced that it has joined the National Association of Boards of Pharmacy PMP InterConnect hub which will allow participating states to share information from prescription monitoring programs to prevent consumers from “doctor shopping” for prescription drugs over state lines.  The New York’s Prescription Monitoring Program, (PMP) is an electronic system allows prescribers and pharmacists statewide to ensure patients do not obtain multiple prescriptions for dangerous controlled substances.  New York prescribers are required to check patient information on the PMP prior to issuing controlled substances, and this requirement was implemented under the ISTOP law.  New Jersey and Connecticut are both on the NABP PMP Interconnet hub, though other neighboring states, including Massachusetts, Pennsylvania and Vermont, are not.  MSSNY strongly supports this move and believes it will give important information to physicians about their patients.


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org 


Tomorrow Is Last Day to Submit PQRS Status Questions
If you have any questions regarding the status of your 2014 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2016, please do not hesitate to submit an informal review request. CMS will be in contact with every individual eligible professional (EP) or PQRS group practice that submits a request for an informal review of their 2014 PQRS data. Additionally, revised 2014 Annual Quality and Resource Use Reports (QRURs) are now available via the CMS Enterprise Portal.  All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which is available now through December 16, 2015 at 11:59 p.m. Eastern Time. 

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

For additional questions regarding the informal review process, contact the Quality Net Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information.


MSSNY Teams with CA, FL and TX Medical Societies to Urge Meaningful Use Reforms
With uncertainty surrounding whether Congress would be able agree to changes to the overly burdensome meaningful use requirements, MSSNY teamed with the medical associations of California, Florida and Texas on a letter this week to CMS Acting Administrator Andy Slavitt urging needed reforms.  In particular, the letter notes that “Physicians across this country are uniformly frustrated, angry, and demoralized by these difficult regulations.  Most physicians are working hard to meet the requirements and cannot because of the lack of specialty measures, the all-or-nothing approach, vendor problems, the lack of interoperability or other issues beyond their control.  Many physicians have been early adopters of technology and are enthusiastic about using EHR as means to improve workflow, patient care and quality outcomes.  However, the EHR incentive program must have feasible and attainable requirements to help physicians achieve these goals rather than act as a burden and hindrance to EHR use by physicians”.

Reforms to the MU program urged in the letter include: delaying implementation of MU Stage 3; giving physicians proportional credit for the measures that are successfully completed, instead of the existing “all or nothing” approach; and expanding the hardship exemptions to recognize physicians who are victims of hacking or other disruptive technology problems related to their vendors, as well as physicians who are close to retirement.


PTSD and TBI in Returning Veterans: Identification and Treatment
Live CME Seminar at Southampton Hospital
Date and time:
January 7, 8-9 AM Live at Southampton Hospital

Presenter:        Dr. Frank Dowling

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

For more information, please read our flyer.

Please register here. 


New York Ties for Top Score in Preventing and Responding to Disease Outbreaks
A December study from Trust for America’s Health (TFAH) states that New York is “tied for top billing in terms of preventing, diagnosing and responding to disease outbreaks.” The TFAH used data from the Centers for Disease Control and Prevention to create a “scoring system with metrics such as flu vaccination rates, food safety and HIV/AIDS surveillance – and then evaluated each of the 50 states to see how they stacked up.” New York is among the five states that “maxed out at 8/10 points.” Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

The report, from TFAH and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea. 


Fight for Healthcare in Rural Communities

By Congressman Tom Reed (NY-23)

I care deeply about protecting access to health care and ensuring residents in rural areas have the resources and services they need. It is only fair that rural residents have equal access to quality primary and pediatric care as those living in urban areas. That is why we fought to secure funding for new health care access points across upstate New York.

Earlier this year, we introduced the Rural Hospital Access Act, which protects access to care by providing enhanced levels of Medicare funding to rural hospitals. This legislation makes permanent both the Medicare-dependent hospital program and the enhanced low-volume Medicare adjustment, which enable rural hospitals to offer the same medical services as are provided by hospitals in large cities. This is critically important because it allows seniors, veterans, and individuals with disabilities to receive quality health care right in their own communities.

The enhanced reimbursements provided by these Medicare programs have a direct impact on rural hospitals across upstate New York. An example is St. James Mercy Hospital, a central access point for residents in Steuben County. This hospital is currently undergoing a major restructuring, as part of a new vision for health care in their community. The enhanced reimbursements are critically important because they provide not only a crucial source of revenue, but also a sense of certainty and stability. This will allow rural hospitals like St. James to effectively serve local residents now and for generations to come.

Many of us depend on rural hospitals and medical facilities for health care, from pediatrics to inpatient and maternity services. It is only right we protect these services by supporting rural hospitals. We will continue fighting to ensure seniors, veterans, and individuals with disabilities have access to the care and services they need, regardless of where they live.

Congressman Tom Reed (NY-23)

2437 Rayburn House Office Building

Washington, D.C. 20515

(202)225-3161


Rep. Sarbanes:  Bill to Allow Retired Doctors to Retrain for Community Health
Rep. John Sarbanes (D-Md.) has reintroduced a bill that would allow physicians who have ceased practicing medicine to receive grants to become retrained if they pledge to work at a community health center, school health clinic or Veterans Affairs medical center for two years. This legislation would establish a grant program for medical schools, hospitals and non-profit organizations to create or expand their physician reentry programs which give physicians a streamlined process for credentialing and continuing medical education to return to medical practice after an absence. Funding could also be used to assist with credentialing fees, loan repayments and salaries. In return for this assistance, these physicians would serve at community health centers, VA medical centers or school-based health centers to help fill the shortage of primary care doctors. Participating physicians would be able to practice on a full- or part-time basis and would be covered under the Federal Tort Claims Act, which provides physicians with medical liability protection. 


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations During a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional programs are: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


MSSNY Adult Immunization Podcast Now Available
William Valenti, MD, chair of MSSNY’s Infectious Disease Committee and Monica Sweeney, MD, MPH, vice chair of MSSNY Committee to Eliminate Health Care Disparities, discuss adult immunization in an effort to educate and inform patients and physicians in New York State about the importance of adult immunization.   The audio podcast can be accessed here. 


CDC Issuing Guidelines Urging Primary Care Physicians to Monitor Opioids
In a research letter in JAMA Internal Medicine, investigators “examined Medicare claims from 2013 to see which doctors prescribed opioids and how many prescriptions they filled.” The analysis revealed that “the drugs are prescribed by a broad cross-section of medical professionals – including doctors, nurse practitioners, physicians’ assistants and dentists – rather than concentrated among a small group of practitioners.”

Moreover, the analysis also revealed that on a “doctor-by-doctor level, pain management specialists and anesthesiologists handed out the most prescriptions for opioids,” but because there are more family physicians than specialists, as a group, “their number of painkiller prescriptions was higher than for any other category of health care worker.

In light of the findings, the Centers for Disease Control and Prevention issued new guidelines on December 14, urging primary-care physicians to closely monitor their patients’ use of opioids and take a more “conservative approach” to prescriptions in order to mitigate “a crippling epidemic of addiction to the powerful narcotics.”

Written comments must be received on or before January 13, 2016. You may submit comments, identified by Docket No. CDC-2015-0112 by any of the following methods:

  • Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
  • Mail:National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE., Mailstop F-63, Atlanta, GA 30341, Attn: Docket CDC-2015-0112.

Instructions: All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to http://regulations.gov, including any personal information provided. For access to the docket to read background documents or comments received, go to http://www.regulations.gov.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

December 11, 2015 – MSSNY Aids Physicians in Taking Control of Their Practices

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 11, 2015
Volume 15, Number 46

Dear Colleagues:

First of all, Happy Chanukah to all who are celebrating the miracle of the holiday.

This year, the MSSNY HOD called for the creation of a Task Force that would explore and recommend options to assist MSSNY’s physicians in independent practice to remain viable in that environment. After a call for interested MSSNY members to participate, I put together a team of physicians from various specialties and geographic locations that had an interest and/or expertise in the subject.  Some physicians have business degrees while others have engaged in entrepreneurial projects transforming how they deliver health and wellness care to the residents of New York.  I selected Drs. Tom Lee and Paul Lograno to lead the effort.  To date, the group has had two meetings and has begun developing various options to help a broad spectrum of physicians in different practice environments. In the next few months, you will be hearing more about options available to you that many of your colleagues have embarked on that have helped them be happier physicians thriving in the turbulent environment of healthcare reform.

In addition to this effort, I have asked a group of MSSNY Councilors to develop guidelines that will guide how we collaborate with other groups of physicians who are seeking to remain out of network or who wish to engage in advocacy that relates specifically to their specialty practice. A Task Force to address physician burnout and stress will begin its deliberations in January under the leadership of Dr. Michael Privetera from the University of Rochester.

Tipping Point

The recent events concerning disenrollment of physicians from Emblem Health and United Healthcare as well as the Health Republic fiasco have become the tipping point.  WE WILL NOT SIT BACK AND TAKE THIS ANY LONGER.  If we cannot get collective negotiation or be assured that the private practice model will be supported by government legislative and regulatory reforms, then we must take matters into our own hands and develop mechanisms for group survival/individual survival.  For some, it will mean creating new physician-owned-and-run groups or IPAs.  For others, it will mean dropping out of many insurance products and establishing direct care practices. For others, there may be other models that some of you have developed.  MSSNY is working on highlighting successful options to opt out of the madness being foisted upon us.

Do you have an interest in getting involved?  Do you have a successful alternative model of delivering healthcare that is working for you?  Have you changed how you practice and become a happier and less stressed out physician while remaining in private practice?  Are you a young physician engaged in an innovative practice model?  We want you to get involved in our grassroots led effort.  Let us know.  We are bringing together talented and successful colleagues who have been quietly engaging successful strategies.

Contact Eunice skelly @ eskelly@mssny.org

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Senate Health Committee Chair Urges Emblem to Reconsider Dropped Physicians
Noting that he has “heard from a number of physicians as well as the Medical Society of the State of New York” regarding Emblem’s decision to not renew contracts with approximately 750 physicians, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani this week to ask for “further clarity on this issue.”   MSSNY had written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services in addition to contacting the State Legislature.

Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Physicians can send a letter to their legislators urging their efforts to reverse Emblem’s action from here.

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.

If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount. We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


Western New York Congressman Presses CMS to Assure That HR Claims Are Paid
Noting the several physicians he has heard from, Representative Chris Collins (R-Western New York) pressed CMS Acting Administrator Andy Slavitt this week to identify what steps the federal government could take to assure physicians and other health care providers are fully paid for the care that they have provided to their patients insured by collapsed co-op health insurer Health Republic.  The questioning occurred as part of a US House of Representatives Energy & Commerce Committee hearing into the functioning of state Exchanges.  MSSNY had written to the entire New York Congressional delegation late last week to share with them the numerous articles from papers in nearly every region across New York State highlighting the consequences of the collapse of Health Republic, and asking for their assistance to assure, once the full accounting and distribution of the assets of the Health Republic is completed, that health care providers are made whole.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  Physicians can send a letter to their state legislators and Governor Cuomo to urge that steps are taken, including the creation of a special state fund, to assure that these claims are fully paid.

Moreover, this week, the New York State Association of Health Underwriters announced its support for a special fund to assure Health Republic claims are paid.

MSSNY also continues to hear from dozens of physicians that reimbursement checks issued by Health Republic have been returned by the bank for insufficient funds.   If you have received notice from your bank that an HR check bounced, please let us know by sending an email to rmcnally@mssny.org


Cadillac Tax, Meaningful Use Relief Under Consideration in Year End Congressional Budget Talks
As Congress scrambles to pass a year end Budget bill, a number of health care issues of great importance to physicians continue to be under strong consideration for incorporation into the package.  This includes additional provisions that could provide some needed hardship exceptions to overly burdensome meaningful use requirements, as well as a delay in the implementation of the so-called “Cadillac Tax” on comprehensive health insurance coverage scheduled to go into effect in 2018.  The Cadillac Tax, a component of the ACA, imposes a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage.  It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers form offering comprehensive health insurance policies to their employees.   MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.  Please remain alert for further updates on these items. 


Take this AMA Survey re Meaningful Use
In the AMA’s ongoing efforts to improve EHRs and interoperability of EHRs, the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use. The following is a link to a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care, thus making it easier to find relevant information.  Please share the link with your members and encourage them to take the survey. The Office of the National Coordinator (ONC) has extended the survey deadline to December 23. Survey link http://goo.gl/forms/0fjoUxZwsS 


BNE Sends Letter Reminding You of E-Prescribing Requirement that Becomes Effective on March 27, 2016
The New York State Department of Health’s Bureau of Narcotic Enforcement has emailedl a letter to about 110,000 prescribers, through the Health Commerce System, reminding practitioners about the e-prescribing mandate that will take effect on March 27, 2016.  The letter encourages practitioners to begin E-prescribing if they have already implemented an E-prescribing software application or to begin the process to acquire an E-prescribing software application if they have not started the process.   A copy of that letter can be found here. BNE has also developed a patient brochure on e-prescribing and it can be found on BNE’s website.

New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016.   The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing.   Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.   According to state officials, over 35,000 prescribers have registered their systems with DOH.   This represents only about 1/3 of the prescribers in New York State.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances.  These include the following:

  • First, the software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page. http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements.
  • Third, you must obtain a two-factor authentication as defined in the federal requirements.
  • Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system.  ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here. There are additional venders that now have software available to e-prescribe both non-controlled and controlled substances and information on these can be found at this link.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so shortly. The waiver process will be electronic. Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary. 


Bureau of Narcotic Enforcement’s Physician Info on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four hour medical use of marijuana course.  Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the  TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the following link.

It is also expected that DOH will announce the process that physicians may be able to “certify” patients for receiving marijuana under the medical marijuana program.   It is anticipated that this process will be through the Health Commerce System.

Please monitor this webpage frequently for updates and the department may be contacted with any questions:New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway,Albany, NY 12204

Call 866-811-7957 or email mmp@health.ny.gov


Letter Re E-Prescribing from Director of Bureau of Narcotic Enforcement

Dear Prescriber:

Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.  This mandate does not apply to veterinarians.  Electronic prescribing of both controlled and non-controlled substances is currently permissible in New York. 

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements.  Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE). 

Please be aware that implementation timelines for EPCS software vary and may be lengthy.  If you have not already begun this process, BNE strongly recommends that you begin immediately.   

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date. 

Useful information related to electronic prescribing, including frequently asked questions, information regarding the EPCS registration process, and a downloadable patient-centered brochure to help your patients better understand electronic prescribing can be found on our website at www.health.ny.gov/professionals/narcotic. 

If you have any questions about the electronic prescribing mandate, please call 1-866-811-7957, option 1.

Joshua Vinciguerra
Director
Bureau of Narcotic Enforcement


The NY Society of Addiction Medicine to Host 12th Annual Conference Feb. 5 & 6
The NY Society of Addiction Medicine (NYSAM) will host its annual conference February 5 and 6 at the Crowne Plaza Times Square Hotel, 1605 Broadway, NYC. The conference entitled, “Critical Role of Addiction Medicine in Healthcare Reform: Best Practices,” is designed for physicians, medical students/residents, and addiction professionals.  Registration is required and the cost is as follows: Full conference price—Before January 15, 2016  NYSAM Member Rate: $350 Non-Member Rate: $425 Non Physician Rate: $225.  Residents/Fellows/Medical Students are free. Registration may be made by visiting the NYSAM website here or by contacting Elisabeth Kranson at (518) 689-0142 or via email: ekranson@asapnys.org 


Adelphi University MBA Program for Suffolk/Nassau County Medical Societies
The Nassau and Suffolk Medical Societies cordially invite all physicians to attend one of the MBA Information Sessions to learn more about how an MBA degree can give you the tools necessary to be an effective leader, critical thinker, negotiator and problem solver. Mark your calendar now and plan to attend.

Where: Suffolk County Medical Society, 1767-14 Veterans Highway, Islandia

  • Tuesday, December 8, 2015
  • Tuesday, December 15, 2015
  • Friday, December 18, 2015

Come in between 4:00 pm to 6:00 pm

Where: Adelphi University, 55 Kennedy Drive, Hauppauge- 11788

  • Monday, December 7, 2015
  • Wednesday, December 9, 2015
  • Monday, December 14, 2015

Come in between 8:00 am to 3:00 pm

Don’t miss out on this opportunity to learn more about how you can successfully position yourself in today’s healthcare system.

RSVP Maureen Leslie at 516 237-8607 or leslie@adelphi.edu or SCMS at 631 851-1400.


Consumers Warned About Raw Milk Listeria Risk in Allegany County
Food Safety News (12/11) reports “consumers in New York’s Allegany County and surrounding area were told not to consume ‘unpasteurized’ raw milk from the Gerald E. Snyder Farm due to possible Listeria contamination.” The notice “came from the New York Department of Agriculture and Markets.”

The public health warning came from the New York Department of Agriculture and Markets.The Gerald E. Snyder Farm is located at RD#1, 1444 Randolph Rd., Alfred Station, NY. The department has not yet associated any illnesses with the product that is subject of the public health warning.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

December 4, 2015 – Are Your Health Republic Checks Bouncing?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
December 4, 2015
Volume 15, Number 45

Dear Colleagues:

As was reported in several media outlets this week, including Crains’ Health Pulse, Politico New York and WNYC, MSSNY has heard from many physicians outraged regarding the decision of EmblemHealth to drop hundreds of physicians from its network reportedly as part of its efforts to increase the use of value-based payments. However, at first glance, it appears that many of the recipients of these non-renewal letters were physicians in smaller practices who did not receive any advance notice by Emblem of its desire to migrate their payment structure to a value-based methodology.

Last week, the New York County Medical Society issued a press release warning of disruptions to long-standing patient-physician relationships, followed up by multiple MSSNY letters to the NYS Department of Financial Services (DFS) urging an investigation into how these actions by Emblem will affect its network adequacy and whether these physicians and their patients were truly given adequate notice.

We have been advised by DFS staff that they have initiated a review of Emblem’s action, and hope to have some answers to our questions next week.  Among the questions we have posed to DFS:

  • Were these 750 physicians dropped by Emblem given any advance notice of Emblem’s intention to drop them for any reasons including because they chose to deliver care to patients in a smaller practice setting?
  • Were any of these 750 physicians dropped by Emblem given the opportunity to enter into the value-based contracts espoused by Emblem to stay within Emblem’s physician network?
  • How many patients are impacted by Emblem dropping these 750 physicians from its network?  What is the total number of patient encounters with Emblem insureds that these 750 physicians provided over the last year?
  • What is the specialty of the physicians being dropped?  What are their hospital affiliations? Has DFS or DOH reviewed whether the dropping of these physicians will create shortages in any specialty or in any particular community served by Emblem?
  • How does the timing of the notice to these dropped physicians intersect with employer open enrollment periods?  For example, it was reported that the open enrollment date for New York City employees ends on October 31, just three days after patients received notice of these physicians being dropped. Were patients of these physicians given fair notice so that they could shop around for coverage for a health plan that includes their treating physicians?

Please let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY’S Advocacy Matters CME Series Webinar On December 8th
Jason Helgerson, NYS Medicaid Director to Discuss Delivery System Reform Incentive Payment Program (DSRIP) and the Move to Value Based Payment

Jason Helgerson, New York’s Medicaid Director, will present on the State’s Delivery System Reform Incentive Program (DSRIP) and on the move to value based payment on MSSNY’s December 8th Advocacy Matters program. The program will run from 12:30- 1:30PM.

DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.

To read our flyer, please click here.

Calling All Doctors Who Have Been Terminated by Emblem
MSSNY is trying to collect data on the physicians who have been terminated by Emblem health. We cannot help you if we do not who you are. We are in constant contact with The Department of Financial Services in an effort to assist New York State physicians who have received these notices from Emblem.

Please email our VP of Socio-Medical Economics Division Regina McNally at rmcnally@mssny.org with your name and contact information. 


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


File by Dec. 16 to Avoid Medicare Pay Cut of 2-4 %
Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.

Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.

How to avoid the penalty: File an informal review request with CMS before midnight EST on Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request.

Additional information about the process and contact information for questions is available in CMS’ informal review fact sheet.

Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9
MSSNY will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members. Registration is now open to MSSNY physicians by clicking here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  •  Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.  


US Senate Passes Controversial Bill to Revise ACA and Defund Planned Parenthood
By a 52-47 vote, the United States Senate passed legislation (HR 3762) on Thursday that would repeal significant components of the Affordable Care Act.  Specifically, the bill would repeal the taxes on medical devices and the so-called “Cadillac” tax on comprehensive health insurance policies (slated to go into effect in 2018).  It would also reduce funding for the Public Health and Prevention fund created under the ACA and repeal the expansion of Medicaid contained in the ACA.  Furthermore, it would set at $0 the fines for individuals who fail to purchase health insurance coverage and large employers who fail to provide coverage to their employees, essentially repealing these mandates.  Of greatest controversy, the legislation would also defund Planned Parenthood for one year.

While the bill is expected to be passed by the House of Representatives, it is almost certainly going to be vetoed by President Obama, and there are insufficient votes for an override.    The significance, however, is that it is likely to be the first time a bill repealing large sections of the ACA has been approved by the entire Congress.  New York’s Senators Charles Schumer and Kirsten Gillibrand voted against the bill.


Revitalizing MSSNY’s Organized Medical Staff Section – Get Involved!
MSSNY members are invited to get involved in the reestablishment of our OMSS. OMSS is a viable entity to advance the interests of your medical staff, your group practice or your institution, and to air and have MSSNY help address your issues.

OMSS also offers a prime opportunity for leadership development.

We would like to invite you to participate in an online meeting at which candidates for office will introduce themselves, and elections will be held. A slate of previously nominated candidates will be presented, and nominations will be accepted from the floor. Even if you are not running for office, please join to have your vote counted. The webinar (telephone only option also available) will take place on Saturday, December 12, 2015 at 8:00 am and should last no more than two hours.

Kindly email eskelly@mssny.org at your earliest convenience to let us know if you will be participating.


Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application. Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com


MSSNY Announces 2016 Medical Matters Schedule for 2016
MSSNY will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During a Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

  • Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.

Further information on these programs can be found here

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Senate Finance Report on Solvadi Pricing: Profits over People
Gilead Sciences prioritized maximizing its revenue over recouping research and development costs and ensuring patient access when pricing its breakthrough hepatitis C treatment, Sovaldi, according to a Senate Finance Committee report released yesterday.

“Gilead pursued a calculated scheme for pricing and marketing its Hepatitis C drug based on one primary goal, maximizing revenue, regardless of the human consequences. There was no concrete evidence in emails, meeting minutes or presentations that basic financial matters such as R&D costs or the multi-billion dollar acquisition of Pharmasset, the drug’s first developer, factored into how Gilead set the price. Gilead knew these prices would put treatment out of the reach of millions and cause extraordinary problems for Medicare and Medicaid, but still the company went ahead,” stated the report. The drug costs $1,000 per pill or $84,000 per patient for a 12-week course of treatment. According to the report, fewer than 3% of eligible Medicaid beneficiaries received the treatment last year because of the drug’s high price. Gilead says it disagrees with the report’s findings, noting that it provides financial assistance for the treatment to uninsured individuals. (Wall Street Journal 12/1)


Mandatory Electronic Prescribing in New York State
Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health, Bureau of Narcotic Enforcement (BNE).

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper. This will allow for time to resolve technical or workflow issues prior to the mandate’s effective date.

Please be aware that implementation timelines for EPCS software vary and may be lengthy. If you have not already begun this process, it is recommended that you begin immediately.

The laws regarding issuing and dispensing prescriptions for controlled substances, from paper to the electronic method, have not changed. Only the format has changed.

Useful information related to electronic prescribing, including frequently asked questions and information regarding the EPCS registration process, can be found on BNE’s website here.


ACEP: Under New Reg, Plans Not Required To Pay Fairly for Emergency Care
A new regulation issued by the Department of the Treasury, the Department of Labor and the Department of Health and Human Services last week stated that health insurance companies can pay doctors in emergency departments essentially whatever they like, opening the door to the possibility of reimbursements that do not even cover the costs of care.  The American College of Emergency Physicians (ACEP) expressed astonishment at the ruling, given the feedback emergency physicians have given to CMS over several years, as well as the timing.  Dr. Jay Kaplan, president of ACEP, said that the organization was considering legal action.

“This new ruling will significantly benefit health insurance companies at the expense of physicians, because they know hospital emergency departments have a federal mandate to care for everyone, regardless of ability to pay,” said Dr. Jay Kaplan.  “They will continue to shift costs onto patients and medical providers, as well as shrink the number of doctors available in plans.  Instead of requiring health plans to pay fairly, this ruling guarantees that insurance companies can pay whatever they want for emergency care.  If history tells us anything it’s that insurance companies prefer to pay as close to nothing as possible, while building their war chest for profits and litigation.”

“This is a scary environment for patients,” said Dr. Kaplan.  “Insurance companies are alleging that doctors are charging too much, rather than admitting they are paying too little.  This ruling by CMS unfortunately suggests that the federal government is on the side of Big Insurance rather than patients and their physicians.”


Classifieds

Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org

Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355